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General NPI Number Information
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NPI Number | 1962592105
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Entity Type | Organization
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Legal Business Name | LAUREL HEALTH CARE COMPANY OF GALESBURG
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 1080 N 35TH ST
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City | GALESBURG
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State | MI
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Zip | 49053-9727
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Country | US
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Telephone | 616-665-7043
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Fax | 616-665-4080
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Provider Business Mailing Address
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Address Line | 1080 N 35TH ST
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City | GALESBURG
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State | MI
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Zip | 49053-9727
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Country | US
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Telephone | 616-665-7043
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Fax | 616-665-4080
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Authorized Official
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Title or Position | CFO
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Name | MR. TIMOTHY PATTON
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Credential |
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Telephone | 614-794-8800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 394150
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License Number State | MI
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